Modeling the impact of environmental and socioeconomic factors on health expenditure in Türkiye

Understanding health expenditure (HE) determinants is imperative for sustainable development. This study examines the impact of ecological footprint (EFP), economic growth (GDP), and refugee and asylum-seeker (RAS) population on HE in Türkiye from 1975 to 2023, employing the autoregressive distributed lag (ARDL) approach with structural breaks. Long-run results indicate that GDP and EFP increase HE, with elasticities of 2.09 and 1.88, respectively, whereas RAS (−0.08) and the 2011 structural break (−0.10) reduce it. In the short run, GDP raises HE (2.28). VECM causality reveals that HE drives GDP and EFP, with unidirectional causality from GDP to RAS, while EFP and RAS exhibit bidirectional causality. These findings imply that while economic growth and environmental pressures inflate health costs, refugee influxes suppress them, likely due to international aid and youth demographics of refugees. Ultimately, policymakers should adopt a “health in all policies” framework that integrates environmental and migration strategies by prioritizing green healthcare infrastructure and sustainable urban planning.